Provider Demographics
NPI:1184038457
Name:LONGLY, CHRISTINE L (ANP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:LONGLY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110398
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0398
Mailing Address - Country:US
Mailing Address - Phone:907-346-8013
Mailing Address - Fax:907-346-4596
Practice Address - Street 1:11331 RIDGECREST DRIVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516
Practice Address - Country:US
Practice Address - Phone:907-346-8013
Practice Address - Fax:907-346-4596
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily